4
What about 99.5% of all cases rescued at the beach, what should be done? What about 99.5% of all cases rescued at the beach, what should be done? How are we to know which cases need an EMT or an MD? ? Should we give oxygen in all cases?, if so, how much? Should we call an ambulance? Should we transport all of them to a hospital? Should we release or keep them a while in observation? How are we to know the prioritization on a busy day?, and Basic Life Support (BLS) - Drowning - Szpilman 2004

5
Do you need to know how to act appropriately and confidently in those cases? Do you need to know how to act appropriately and confidently in those cases? On a busy day, as a lifeguard, would you get medical support as quickly as you needed? On a busy day, as a lifeguard, would you get medical support as quickly as you needed? or Basic Life Support (BLS) - Drowning - Szpilman 2004

6
That´s why rescuers need a DROWNING CLASSIFICATION SYSTEM That´s why rescuers need a DROWNING CLASSIFICATION SYSTEM It allows Lifeguards and MD teams to speak the same language It gives the exact severity of the case It gives exactly what approach should be taken It advises when to call an ambulance It advises when to call an EMT or a MD It reassures lifeguard’s in front of the population, and Basic Life Support (BLS) - Drowning - Szpilman 2004

7
DROWNING CLASSIFICATION SYSTEM How it was created and applied DROWNING CLASSIFICATION SYSTEM How it was created and applied It was recently (2001) validated by a 10 year study with 46,060 rescues, of which 930 (2%) were drownings attended at the Drowning Resuscitation center (DRC) It was recently (2001) validated by a 10 year study with 46,060 rescues, of which 930 (2%) were drownings attended at the Drowning Resuscitation center (DRC) It was updated in 1997 to a new medical perspective It was based on the evaluation of 41,279 rescues The final group evaluated came from 1,831 medical reports It was based on beach and hospital attendance Only clinical parameters were considered to facilitate the use It was adapted to be understood by lifeguards It’s been used since 1973 by more than 3,000 lifeguards in Rio de Janeiro It was created in 1972 by MD and lifeguards working together

11
NO COUGH or FOAM IN MOUTH or NOSE Mortality - 0% NO COUGH or FOAM IN MOUTH or NOSE Mortality - 0% Drowning Classification - BLS Based on evaluation of 1,831 cases - CHEST - September 1997 Evaluate and release from the accident site without further medical care Basic Life Support (BLS) - Drowning - Szpilman 2004

12
COUGH, WITHOUT FOAM in MOUTH or NOSE MORTALITY - 0% COUGH, WITHOUT FOAM in MOUTH or NOSE MORTALITY - 0% Drowning Classification - BLS Based on evaluation of 1,831 cases - CHEST - September Warm and calm the victim. 2. Advanced medical attention or oxygen not usually required 1. Warm and calm the victim. 2. Advanced medical attention or oxygen not usually required Basic Life Support (BLS) - Drowning - Szpilman 2004

17
1. Start and continue CPR. 2. Use External Automatic Defibrilator if possible. 3. No one is considered dead if hypothermic 4. Do not resuscitate if submersion time over 1 hour or obvious physical evidence of death. 5. After successful CPR, victim should be followed as closely as possible and treat as grade 4.grade 4 Drowning Classification - BLS Based on evaluation of 1,831 cases - CHEST - September 1997 CARDIOPULMONARY ARREST MORTALITY - 93% CARDIOPULMONARY ARREST MORTALITY - 93% Basic Life Support (BLS) - Drowning - Szpilman 2004

18
Basic Life Support - DROWNING CLASSIFICATION and TREATMENT Based on evaluation of 1,831 cases - CHEST - Sep 1997 Grade 4 (19.4%) Grade 3 (5.2%) Reaction to ventilation or any movement? Yes No Grade 6 (93%) Grade 5 (44%) Yes Check for cough and/or foam in mouth/nose Grade 1 (0.0%) SMALL AMOUNT OF FOAM IN MOUTH/NOSE Grade 2 (0.6%) LARGE AMOUT OF FOAM IN MOUTH/NOSE RADIAL PULSE PALPABLE ? Yes COUGH, WITHOUT FOAM IN MOUTH/NOSE No Algorithm BLS: Near each grade the general mortality (%) is shown. Heimlich maneuver is only indicated with strong suspicion of foreign body obstruction; There is no difference in basic life support between different types of water drowning. (*)If the victim is grade 5, ventilation in-water can reduce mortality by almost 50%. CPA (Cardiopulmonary Arrest). References with the author Give 2 mouth to mouth breaths and check for signs of circulation Start complete CPR with 15 external chest compressions and alternate with 2 breaths until normal cardiopulmonary function is restored, ambulance arrives or lifeguard exhaustion. After successful CPR, the victim should be followed as close as possible because another CPA may occur. Continue mouth to mouth at 12 to 20 p/min until restore normal breath Check the victim response NoYes BREATH PRESENT? Absent Rescue (0.0%) Evaluate and release from the accident site without further medical care 1. Warm and calm the victim. 2. Advanced medical attention or oxygen not normally required 1. Oxygen - 5 L/min by nasal cannula. 2. Warm and calm the victim. 3. Hospital observation from 6 to 48 hours. No 1.15 liters/min of oxygen by face mask at the accident site. 2. Right side recovery position. 3. ACLS and hospitalization in ICU required liters/min of oxygen by face mask. 2. Monitor breathing with care (may still stop breathing). 3. Right side recovery position. 4. ACLS immediately with mechanical ventilation and I.V fluids. 5. Hospitalization in ICU required After restoring spontaneous breathing and pulse, treat as grade 4 Warning: if any suspicion of cervical spine injury(0,5%), be careful while open airways - use special techniques to do so. Hospitalization Check for breathing - Open airways - look, listen and feel for respiration Check the victim in-water Conscious victim: bring back to shore/pool deck.; Unconscious victim - Shallow water: open victim’s airway, evaluate breathing, and begin mouth to mouth if necessary. Deep water: place the victim face up and open airway. If no spontaneous breathing, start mouth-to-mouth ventilation immediately at a rate of 12 to 20/min until reaching shore/swimming pool deck*. Mouth-to-mouth is possible in the water with 2 lifeguards or 1 lifeguard with lifesaving equipment. Do not check victim’s pulse while in the water. If no signs of circulation, don’t start chest compressions in-water, urgently bring the victim back to shore without further procedures. On shore/pool deck - victim’s trunk and head should be at same level, even in sloping sites Do not spend time trying to drain water from the lungs. Victim position of head lower than trunk will increase the occurrence of vomit or regurgitation. On sloping beaches all the victims should be put initially parallel to the waterline, in dorsal position. Lifeguard with his back to the sea with the victim’s head turned to lifeguard´s left side. This facilitates the rescuers CPR maneuvers so that he does not fall over the victim and makes placing the victim in right lateral decubitus easier. Victim transport to shore/pool deck should be with head up (except for hypothermic victim) Submersion time over 1 hour or obvious physical evidence of death (rigor mortis, putrefaction or dependent lividity). NoYes Dead Do not resuscitate MORGUE Szpilman Published in: Circulation 2000, 102 (suppl I):I & Pediatric Clinics of North America, June 2001

19
ONE TEAM, ONE GOAL LIFEGUARDS and MEDICAL STAFF

20
ONE WORLD, ONE DROWNING LANGUAGE ONE WORLD, ONE DROWNING LANGUAGE WE CARE ABOUT Ils Medical Comission